Risk factors for surgery in Crohn's disease

A study in November's issue of the American Journal of Gastroenterology estimated the need for surgery in an American population-based cohort of Crohn's disease.

Dr Edward Loftus and colleagues from Minnesota, USA estimated the need for surgery in an American population-based cohort of Crohn's disease.

The medical records of 310 incident cases of Crohn's disease from Olmsted County, Minnesota, diagnosed between 1970 and 2004, were reviewed through March 2009.

The researchers estimated the cumulative incidence using the Kaplan–Meier method, and associations between baseline factors and time to first event were assessed using proportional hazards regression and expressed as hazards ratios with 95% confidence intervals.

Median follow-up per patient was 12 years.

The research team noted that 152 patients underwent at least 1 major abdominal surgery, 65 had at least 2 surgeries, and 32 had at least 3 surgeries.

The researchers found that cumulative probability of major abdominal surgery was 38%, 48%, and 58% at 5, 10, and 20 years after diagnosis, respectively.

Baseline factors significantly associated with time to major abdominal surgery included ileocolonic, small bowel, and upper gastrointestinal extent.

The team noted that factors associated with colonic surgery alone included current cigarette smoking, male gender, penetrating disease behavior, and early corticosteroid use.

The doctors noted that major abdominal surgery rates remained stable, with 5-year cumulative probabilities in 1970–1974 and 2000–2004 of 38% and 35%, respectively.

Dr Loftus' team concluded, "Cumulative probability of major abdominal surgery in this population-based cohort of Crohn's disease approached 60% after 20 years of disease, and many patients required second or third surgeries."

"Non-colonic disease extent, current smoking, male gender, penetrating disease behavior, and early steroid use were significantly associated with major abdominal surgery."